Porter Adventist Hospital

Endoscopic retrograde cholangiopancreatography (ERCP) is commonly used to treat pancreaticobiliary diseases, but can be technically challenging, leading to occasional unsuccessful attempts. While repeat ERCP is one option in these cases, data on the effectiveness and safety of this practice remain limited. Thus, we conducted a systematic review and meta-analysis to assess outcomes of repeat ERCP after initial unsuccessful attempt. MEDLINE, Embase, and CENTRAL were searched on February 28, 2025. We included randomized trials and observational studies reporting on outcomes of repeat ERCP following an initial unsuccessful attempt, with the primary outcome being technical success of cannulation, and secondary outcomes including adverse events (AEs). Random-effects models were used to pool data, and heterogeneity was assessed through the I2 statistic. A total of 22 studies involving 1514 patients with a median age of 62 years were included. The majority of studies were conducted at a single center (86.4

Clinically significant post-endoscopic mucosal resection bleeding (CSPEB) is one of the most common adverse events after EMR. In this meta-analysis, we evaluated the efficacy of prophylactic clipping after EMR of proximal, large (≥ 20 mm) nonpedunculated colon polyps. We reviewed several databases from inception to September 19, 2025. Outcomes of interest were CSPEB, perforation, post-polypectomy syndrome, and abdominal pain. Pooled risk ratios (RRs) with 95

Background Self-reported cannabis use in patients undergoing total knee arthroplasty (TKA) has increased since its legalization. Despite endorsement, its efficacy has never been studied in a prospective randomized study in orthopaedic surgery. The purpose of this study was to determine whether a synthetic delta-9-tetrahydrocannabinol (sTHC), dronabinol, decreases opioid use after TKA. Methods There were 163 patients who underwent primary unilateral TKA who were prospectively randomized into receiving dronabinol (2.5 mg twice a day, n = 81) versus a placebo pill (2.5 mg twice a day, n = 82) as an adjunct to pain management. Patients, providers, our statistician, and the research team were blinded to the groups. Patients were cannabis naïve and had drug screening prior to surgery. Patients received our standard perioperative multimodal pain regimen (including opioids) regardless of randomization. The primary outcome was opioid morphine milligram equivalents (MME) at two weeks. Secondary outcomes included self-reported pain, sleep scores, nausea/vomiting, knee range of motion, and patient-reported outcomes. Patients were followed for six weeks after TKA. Statistical significance was accepted at P ≤ 0.05. Results There were no differences for in-hospital MME consumed (sTHC 40.1 ± 74.8 versus placebo 38.8 ± 76.4, P = 0.901), or in total MME noted at two weeks (sTHC 383.6 ± 309.8 versus placebo 367.6 ± 246.3, P = 0.717). Self-reported pain (P = 0.581; 0.710), hours of sleep per night (P = 0.103; 0.140), and nausea/vomiting (P = 0.689; 0.158) showed no differences between the groups at two and four weeks. No differences in patient-reported outcome measures at six weeks were noted between groups. There were no drug- or placebo-related complications were noted in either group. Conclusions Despite enthusiasm for cannabis after orthopaedic surgical procedures, this sTHC does not appear to limit opioid intake after primary TKA. Based on these data, THC may offer no benefit for patients after TKA.

Prophylactic clip closure after endoscopic submucosal dissection (ESD) may be beneficial in the prevention of adverse events. In this meta-analysis of randomized controlled trials, we have evaluated the role of prophylactic clipping after ESD. We reviewed multiple databases from inception to 24 January 2026. Outcomes of interest included post-ESD bleeding, perforation, and post-ESD coagulation syndrome. Risk ratios with 95% confidence intervals (CIs) were calculated. Data were analyzed using a random-effects model. Heterogeneity was assessed using the I2 statistic. Five randomized controlled trials with 772 patients were included. Prophylactic clipping was associated with a lower risk of post-ESD bleeding (risk ratio: 0.35, 95% CI: 0.18, 0.65). There was no significant difference in risk of post-ESD coagulation syndrome (risk ratio: 1.06, 95% CI: 0.73, 1.53), and perforation (risk ratio: 0.72, 95% CI: 0.23, 2.30) between the groups. In conclusion, this meta-analysis demonstrates the benefits of prophylactic clipping after colorectal ESD in the prevention of post-ESD bleeding.

EUS-guided radiofrequency ablation (EUS-RFA) has gained recognition in the last decade as a preferred alternative method for pancreatic neuroendocrine tumors (PNETS) where surgical resection is contraindicated. However, clinical outcomes of EUS-RFA for PNETS have not been well studied due to variability in procedure techniques and lack of data from good-quality studies. In this meta-analysis, we aim to study the pooled clinical outcomes of EUS-RFA in patients with PNETS. We searched multiple electronic databases and conference proceedings from inception through Jan 2024. The clinical outcomes studied were pooled technical success, clinical success, and adverse events. We also performed a subgroup analysis based on the sample size of the studies. Standard meta-analysis methods were employed using the random-effects model, and heterogeneity was studied by I 2 statistics. We analyzed 11 studies, which included 7 prospective and 4 retrospective studies involving 345 patients (55.3% females with a mean age of 58.73 ± 3.01 years) having a mean tumor size of 13.87 ± 0.82 cm and a mean duration follow-up of 13.36 months. Technical was assessed on per session basis, defined by EUS-guided access to PNETs along with the completion of the planned ablation procedure. Clinical success was defined as symptom resolution in functional lesions or complete ablation/disappearance or absence of imaging (cross-sectional or EUS) enhancement in nonfunctional lesions upon follow-up. The pooled technical success rate of EUS-RFA for PNETS was 97.6% (confidence interval 93.3%-99.2%; I 2 = 0%), and the pooled clinical success rate was 88.2% (76.3%-94.6%; I 2 = 74%). The pooled overall adverse event rate associated with EUS-RFA for PNETS was 19.6% (15.3%-24.9%; I 2 = 0%). The pooled rates of pancreatitis, bleeding, perforation, infection, and abdominal pain associated per procedure were as follows: 9.1% (6.2%-13.2%; I 2 = 0%); 4.0% (1.9%-8.2%; I 2 = 0%); 2.3% (1.0%-5.4%; I 2 = 0%); 2.3% (1.0%-5.4%; I 2 = 0%) and 8.8% (5.4%-14.1%; I 2 = 0%), respectively. There were no reported deaths with EUS-RFA. Due to the presence of small sample-size studies, subgroup analysis based on patient sample size of number (N) >20 and (N) <20 was performed. The pooled clinical success rate for studies with N >20 was 90.6% (68.1%-97.7%), whereas for studies with N <20 was 83.0% (69.3%-91.4%). On meta-analysis of EUS-RFA for PNETS, the overall technical success was 97.6%, the clinical success rate was 88.2%, and the overall adverse events was 19.6%. A key finding of this study was the pooled pancreatitis rate of 9.1%. Future studies are warranted to study methods aimed at pretreatment prophylactic measures to prevent this significant adverse event.